Request for Release of Funds to Beneficiary 1 of 2 Created: June 2019
CALIFORNIA STATE UNIVERSITY CHICO
FINANCIAL SERVICES
STUDENT FINANCIAL SERVICES
STUDENT SERVICES CENTER
ROOM 230
CHICO, CA 95929-0242
530-898-5936
www.csuchico.edu/sfin
Request for
Release of
Funds to
Beneficiary
DECLARATION IN SUPPORT OF REQUEST FOR RELEASE OF FUNDS HELD BY
STUDENT FINANCIAL SERVICES TO A BENEFICIARY OF A DECEASED PERSON
SUPPOR
TING DOCUMENTATION
Attach the following documents that evidence your relationship to the decedent or proof that you are the legally
appointed personal representative of the decedent and that prove your right to the funds on deposit:
•
A copy of the decedent's will, if any,
•
Decedent’s death certificate;
•
Marriage certificate, if you are the decedent’s spouse;
•
Your birth certificate, if you are the decedent’s child
•
or that otherwise establish, with documentary proof, the existence of a blood or legal relationship to either
the decedent or his or her predeceased spouse, if any, that proves your right to the funds on deposit.
The documentary proof, if regular on its face, need not be certified.
At least forty (40) days must have elapsed since the death of the decedent.
Provide reasonable proof of your identity for purposes of this declaration as follows:
Execute this declaration in the presence of CSU, Chico staff; AND provide:
•
Current state or federal identification w/photo, OR
If you are unable to execute this declaration in the presence of staff, an notary public’s certificate of
acknowledgement identifying you as the person executing the declaration is reasonable proof of identity.
Please check one of the following:
No proceeding is now being or has
been conducted in California for administration of the decedent's
estate.
The decedent's personal representative has consented in writing to the payment, transfer, or delivery to
the affiant or declarant of the property described in the affidavit or declaration.
Note: All documentation submitted to CSU, Chico may be subject to disclosure under public records laws.
I hereby certify that I am entitled to the funds on deposit. I declare under penalty of perjury that the foregoing
information is correct and that the documents I have submitted are either originals or true copies of originals.
Signature of Claimant Date:
CLAIMANT INFORMATION
Name of Claimant: Amount of Claim:
Claimant’s Address: Claimant’s Phone Number:
Claimant’s Mailing Address (if different from above):
Decedent’s Name: ____Claimant’s Relationship to the Decedent: _______________________
